Modern Pediatrics. Ukraine

Attention deficit hyperactivity disorder in children aged 6-8 as a medical and social problem

S.V. Hryshchenko — 2024-02-28

One of the medical and social problems that are considered urgent today is the need to improve the health of children with disorders of mental development, including attention deficit hyperactivity disorder (ADHD).

Purpose - to conduct a systematic analysis of scientific sources regarding the etiopathogenesis, clinical manifestations, and joint practical work of doctors, social workers, and teachers regarding ADHD in children 6-8 years old.

Domestic and international studies prove that the treatment of ADHD in children should be comprehensive, include recommendations on regime and lifestyle, drug therapy, and practical recommendations from an educational component.

A multidisciplinary approach to determine clinical-psychopathological and clinical-psychological regularities of the mental development of children with ADHD is relevant. A feature of such children is high activity, inability to focus on one thing, short-temperedness. But such a condition can be corrected if treatment is started as early as possible.

The cause of the development of the disorder can be: complications during pregnancy (this includes early toxicosis, preeclampsia, intrauterine hypoxia of the fetus), complications during childbirth (premature, rapid); low body weight of the child at birth or suffered serious diseases during the first year of life; the presence of bad habits in a pregnant woman, hard work or work in harmful conditions during the period of bearing the fetus.

The main signs of attention deficit hyperactivity disorder in children 6-8 years old are as follows: inattention; hyperactivity; impulsiveness. The main symptoms of ADHD can also be accompanied by accompanying symptoms: difficulties in learning, even despite high intellectual abilities; tics; quick fatigue; the presence of phobias, anxiety and depression; autism; sleep problems; speech or behavior disorders.

Scientists consider the features of intellectual development of children with ADHD to be voluntary regulation of mental activity, cognitive functions, speech, voluntary motor activity, insufficient development of perceptual-gnostic and emotional spheres.

No conflict of interests was declared by the author.

Rational antibiotic therapy for respiratory tract infections in children: modern recommendations

O.O. Rechkina — 2024-02-28

Diseases of the respiratory tract remain relevant in pediatrics.

Purpose - to provide modern recommendations for the prescription of rational antibiotic therapy for respiratory tract infections in children to improve clinical practice and preserve the effectiveness of antibacterial drugs.

The principles of optimal use of antibacterial drugs in the treatment of respiratory diseases in pediatric practice are discussed. The data of the study of the pharmacological profile of azithromycin, its effectiveness and safety in the treatment of respiratory diseases are presented. A detailed analysis of the drug's spectrum of action, its pharmacokinetics, and the possibility of side effects is provided. The study includes the results of clinical trials and meta-analyses, emphasizing the importance of choosing the right dosage and duration of treatment.

The presented results contribute to the understanding of optimal approaches to the use of azithromycin in the treatment of respiratory diseases in children, contributing to the improvement of clinical practice and maintaining the effectiveness of antibiotic therapy.

No conflict of interests was declared by the author.

Structure of sensitization to fish and seafood in children

Yu.V. Marushko — 2024-02-28

In recent years, about 4% of children and 1% of adults in the world have suffered from food allergies to fish and seafood. About 40% of children have a high level of threat of systemic reactions. Literature data on the prevalence of FA on fish and seafood in the world are summarized, the principles of modern diagnostics are defined, taking into account the possibilities of molecular component diagnostics of fish and seafood allergen molecules.

Purpose – To analyze the prevalence of allergies to fish and seafood in children; determine the structure of sensitization to the main allergens of these products using molecular component diagnostics.

Materials and methods. 29 children aged from 3 to 18 years with clinical signs of allergies to fish and seafood were examined, with confirmation of sensitization to them using the ALEX-2 molecular component diagnostic method (Macro Array Diagnostics GmbH, Austria). Levels of specific IgE were determined.

Results. Among those examined, children with food allergies to fish and seafood aged 3-6 years predominated (41.4%). 18 (62.1%) children had a severe allergy history. 19 (65.5%) children had oral allergy syndrome; 18 (62.1%) children had a papular rash with itching. Difficulty breathing was observed in 16 (55.2%) children. About half of the subjects were sensitized to fish allergens, most often to β-parvalbumin. Only 4 (13.8%) children were sensitized to fish enolase and eldolase. Among seafood, sensitization to squid predominated in children - in 18 (62.1%) children, while sensitization to tropomyosin was low - 1 (3.4%) case.

Conclusions. The problem of the appearance of fish and seafood is relevant today, especially among children aged 3-6 years (41.4%). In children with fish allergy, sensitization to β-parvalbumin of different fish species predominated, namely to salmon (51.7%), mackerel (51.7%), herring (48.3%), carp (48.3%), tuna (48.3%), cod (41.4%). As a result of sensitization to seafood, sIGE was more often recorded to extracts of squid (62.1%), oyster (27.6%), lobster (20.7%), mussels (20.7%), clam (17.2%).

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Age characteristics of the course of rotavirus infection in children and the contribution of the osmotic component in the pathogenesis of the diarrhea syndrome depending on age

N.V. Vorobiova — 2024-02-28

Purpose - to identify the age-specific features of the course of rotavirus infection (RVI) in children and to clarify the role of the osmolar component in the pathogenesis of diarrheal syndrome in young children.

Materials and methods. 100 young children with RVI were examined. Children were divided into 3 age subgroups: 1-6 months, 6-12 months and 13-24 months. A comparative analysis of the manifestation and features of the clinical course of the disease was carried out in the subgroups. A comparative assessment of the level of undigested sugars in feces and concentrations of short-chain fatty acids (SCFA) in the dynamics of the disease were carried out. The total level of carbohydrates in feces was determined on the 2^nd, 5^th, 7^th and 10^th day of RVI using the Benedict test. Concentrations of SCFA (acetate, propionate, butyrate) were determined on 2^nd, 5^th and 10^th days by liquid chromatography. As physiological indicators of the total amount of carbohydrates in the feces and fecal concentrations of SCFA, the indicators of 30 relatively healthy children were taken. The "STATISTICA for Windows 13" program was used for statistical processing of the obtained data. Since the quantitative values that were analyzed had a distribution that differed from normal, non-parametric statistical methods were applied.

Results. Children 1-6 months of age with RVI less often had fever and vomiting (p˂0.05), had longer diarrhea (p˂0.05), which was more often accompanied by flatulence, intestinal colic (p˂0.05), than children 13-24 months of age. Children of this subgroup had the highest levels of carbohydrates in feces in the acute period of RVI (р˂0.05 on the 2nd and 5th day relative to children 6-12 months and 13-24 months of age) and in the period of convalescence (р˂0.05 on 10^th day for children 13-24 months of age). In all subgroups of children, reduced concentrations of SCFA were noted in the acute period of RVI (p>0.05 relative to the reference values from the 3^rd to the 5^th day). The most pronounced decrease in the total concentrations of SCFA (p<0.01 relative to the reference values) during the entire period of RVI were observed in children 1-6 months of aged.

Conclusions. RVI is characterized by longer diarrhea which is more often accompanied by flatulence and intestinal colic in children 1-6 months of age, while children 13-24 months of age more often have fever and vomiting. The most pronounced disturbances of carbohydrate metabolism in the intestines and changes in the functional activity of the intestinal microflora during RVI occur in children 1-6 months of age.

No conflict of interests was declared by the authors.

Experience of using the probiotic Bacillus clausii UBBC-07 in children of early age with acute watery diarrhea in the conditions of a hospital department

O.K. Koloskova — 2024-02-28

Acute watery diarrhea in children remains an urgent problem in pediatrics due to its high prevalence and high mortality rates at an early age. Modern treatment protocols provide for a comprehensive approach to the treatment of patients. However, the main method of treatment of diarrhea - oral rehydration, does not allow for the stoppage of the progression of gastroenteritis, of the elimination of the imbalance of microflora and intestinal dysfunction. Such tasks can be solved thanks to the use of probiotics, which are recommended as a component of auxiliary therapy for children with acute infectious diarrhea.

Purpose - to conduct a comprehensive clinical and epidemiological analysis of the results of the use of the spore-forming probiotic Bacillus clausii (B. clausii) strain UBBC-07 (Lactiale Germina) in the complex treatment of hospitalized young children with acute infectious watery diarrhea syndrome.

Materials and methods. 85 children with acute infectious non-inflammatory diarrhea were comprehensively examined. 2 clinical groups were formed. The Group I - 50 hospitalized children (average age 3.1±0.4 years, the proportion of boys - 64.0%), who received 1 bottle of Lactiale Germina 1 time/day in complex treatment (5 ml=2×10⁹ CFU B. clausii endospores). The Group II included 35 patients (average age 2.4±0.4 years (p>0.05), the share of boys - 54.3% (p>0.05)); who received standard treatment according to existing standards. According to the main clinical characteristics, the comparison groups can be considered comparable.

Results. The analysis of the conducted studies established that the use of Lactial Germin increased the chances of a three-fold reduction in the frequency of bowel movements on the 4^th day (absolute risk increase (ARI) - 27.0%, relative risk increase (RRI) - 34.6 (95% CI: 25.4-44.8) with the minimum number of patients who need to be treated to obtain a positive result (MNP) - 2.9 (95% CI: 0.5-8.6), led to the absence of the symptom of vomiting already for the 3^rd day of inpatient treatment (ARI - 9.0%, RRI - 37.5 (95% CI: 28.0-47.7) with MNP - 2.7 (95% CI: 0.4-8.1), increased the chances of a lower need for long-term (≥3 days) parenteral rehydration (ARI - 12.9%, RRI - 13.7% (95% CI: 7.6-22.1) with MNP - 7.3 (95% CI: 2.9-14.3) and reduced the risk of needing to use antidiarrheal agents (relative risk - 3.2 (95% CI: 2.6-3.9) with an odds ratio - 7.1 (95% CI: 3,4-14,7)).

Conclusions. Food supplement Lactiale Germina (probiotic strain B. clausii strain UBBC-07) in the complex treatment of children with acute watery diarrhea is effective and safe with good tolerability and rapid rates of clinical recovery.

No conflict of interests was declared by the authors.

Evaluation of Knowledge, Attitudes, and Practices towards Vaccination among Patients with Spina Bifida in Ukraine

O.R. Boyarchuk — 2024-02-28

Patients with spina bifida (SB) face an increased risk of infection due to frequent exposure to medical procedures and visits to healthcare centers, including rehabilitation centers. Infection can lead to complications in kidneys and urinary bladder, disrupt rehabilitation efforts, and reduce the quality of life.

Purpose - to assess the knowledge, attitudes, and practices related to vaccination among patients with SB and identify the reasons for the low vaccination rates in this group of children.

Materials and methods. An anonymous online survey was conducted among 56 parents of patients with SB. The questionnaire evaluates the knowledge (10 questions), attitudes and practices (4 questions) towards vaccination among parents of patients with SB in Ukraine. The results were analyzed using standard procedures with Statistica StatSoft 6.0 software package. Continuous variables were expressed as a mean and standard deviation (SD). The comparison of frequency parameters was performed using the Chi-square test. The differences between the parameters were statistically significant at p<0.05.

Results. Overall, parents demonstrated good knowledge about the role of vaccines in preventing serious diseases (61.7% gave correct answers), and the percentage of correct answers did not significantly differ between vaccinated, partially vaccinated, or unvaccinated groups of children. However, only 12.5% of SB patients were fully vaccinated and 51.8% were completely unvaccinated. Among the unvaccinated, the majority (55.2%) indicated non-recommendation by specialist doctors (neurosurgeon, neurologist, etc.) as the main reason. Primary care physicians were less likely to not recommend vaccination. Delayed vaccination was primarily due to fear of adverse reactions (40%). Despite low vaccination rates, parents generally had a positive attitude towards vaccination (only 5.4% against). Doctors remained the most influential source of information (63.4%).

Conclusions. A study suggests a need to enhance knowledge among healthcare professionals, increase public awareness, and provide education within patient groups to improve immunization coverage and protect SB children from preventable infectious diseases.

No conflict of interests was declared by the authors.

The influence of smoking on the cytogenetic status of the oral mucosa in teenagers and young adults

I.S. Lisetska — 2024-02-28

Cytogenetic monitoring provides information on both the health status of the population under study and the impact of genotoxic factors, i.e., the cytogenetic status of a person can serve as a biomarker of the level of exposure to genotoxicants, including various types of smoking.

Purpose - to investigate the effect of different types of smoking on the cytogenetic status, namely, to analyse the cariological parameters of buccal epithelial cells of the oral mucosa in teenagers and young adults.

Materials and methods. The cytogenetic status was studied by analysing the karyological parameters of buccal epithelial cells of the oral mucosa in 114 adolescents aged 15 to 24 years, who were divided into groups: the Group I included 26 people who smoke traditional cigarettes; the Group II - 22 people who smoke electronic cigarettes (vapes); the Group III - 23 people who smoke tobacco heating devices (IQOS); the Group IV - 43 people without smoking habits.

Results. A significant increase in epithelial cells of buccal epithelium with nuclear disorders was found in smokers compared to the group of people without smoking habits. In addition, in individuals without smoking habits, no nuclear disorders such as protrusions, proliferation rates, early stage of nucleus destruction and completion of nucleus destruction were detected.

Conclusions. The sensitivity of buccal epithelial cells to the effects of different types of smoking was established, which affects changes in cariological parameters.

No conflict of interests was declared by the author.

Analysis of the frequency of manifestation of isolated and combined developmental defects of the musculoskeletal system of primery school-aged children

S.M. Lukianchyk — 2024-02-28

Over the past few decades, there has been a significant decrease in the number of healthy children, while the number of children with chronic illnesses, developmental disorders, various forms of postural issues, and scoliosis has significantly increased.

Purpose - to determine the frequency of manifestation of developmental abnormalities in the spine, chest, foot, and lower jaw, as well as detection of variations and characteristics of their combinations in younger school children to develop new and improve existing criteria for early diagnosis of musculoskeletal development disorders and the correct selection of methods for their correction.

Materials and methods. In order to conduct the study as part of preventive check-ups with parental informed consent, 200 children (100 boys and 100 girls) aged 6-9 years were examined. The working group was formed using the randomization method. The groups of boys and girls were further divided into 4 age groups, (6 years, 7 years, 8 years and 9 years) each consisting of 25 children. We determined the shape of the chest , the symmetry of processus mastoideus, claviculae and fossa supraclaviculare, scapulae, cristae illiacae, maleolus medialis, the condition of the foot arch and the lower jaw development.

Results. Among the total number of examined children, isolated or combined variations of the following developmental abnormalities of the musculoskeletal system were found in 21.5% of cases. Isolated developmental abnormalities of the musculoskeletal system were found in 10% of examined boys and 8% of examined girls. Various combinations of detected abnormalities were found to manifest in 13% of boys and 12% of girls. Thoracic scoliosis is present in 16% of boys and 14% of girls; developmental issues of the lower jaw affect 9% of boys and 8% of girls, scoliosis of the cervical spine affects 4% of boys and 3% of girls; 6% of boys and 5% of girls have chest deformities and lumbar spine scoliosis.

Conclusions. Developmental musculoskeletal abnormalities were found in 21.5% of children of. The frequency of combined developmental abnormalities increases with age.

No conflict of interests was declared by the authors.

Experience of using Bioplasmix throat spray in the complex treatment of acute viral pharyngitis in children with an atopic background

Yu.V. Marushko — 2024-02-28

The problem of therapy of acute respiratory infections in children remains relevant. The most common infectious pathology of the upper respiratory tract in both children and adults is acute viral pharyngitis. Irrational prescribing of antibiotics leads to medication-induced side effects and the spread of resistance of microorganisms to antibiotics in society. Topical application of respiratory probiotics may be an important component in the supportive treatment of acute respiratory infections and reducing antibiotic dependence. The use of probiotics in children with an atopic background is of particular importance due to the possible occurrence of adverse reactions.

Purpose - to assess the safety and effectiveness of the local application of Bioplasmix throat spray in the complex treatment of acute viral pharyngitis in children with an atopic background.

Materials and methods. 45 children aged 6-18 years with acute viral pharyngitis took part in the study. 2 research groups were formed: the Group I - main (n=25) - received protocol treatment + Bioplasmix throat spray locally and the Group II - comparison (n=20) - only protocol treatment. All patients were assessed for the severity of clinical symptoms (fever, headache, sore throat, scratching, cough) and oropharyngoscopy data (hyperemia, swelling of the mucous membrane of the oropharynx, granularity of the back wall of the pharynx) on the 1^st, 2^nd, 3^rd, 4^th, 5^th and 7^th days of using the product.

Results. The use of the local application of Bioplasmix throat spray for acute pharyngitis in children ensures a faster reduction in the severity of the main clinical manifestations and signs of inflammation of the oropharynx. In the Group I, compared to the Group II, there were better indicators of a decrease in the severity of cough (1.2±0.91 points vs. 1.76±0.85 points), a scratching (1.12±0.92 points vs. 1.7±0.86 points), sore throat (1.6±0.81 points vs. 2.23±0.76 points) and hyperemia of the pharynx (1.4±0.7 points vs. 2.1±0.9 points) from the 3^rd day, swelling of the pharynx (1.22±0.86 points vs. 1.8±1.04 points) from the 4^th day. Adverse reactions were not noted during the use of the local application of Bioplasmix throat spray.

Conclusions. Local probiotic therapy is an important component of the complex therapy of acute pharyngitis, the use of bacteria of the genus Bacillus in the form of Bioplasmix throat spray shows a positive effect on the course of acute viral pharyngitis in children, which manifests by a faster decrease in the severity of subjective symptoms of pharyngitis and inflammatory signs of the oropharynx.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interest was declared by the authors.

Clinical manifestations of Hirschsprung’s disease in children aged 1 to 3 years

O.O. Kurtash — 2024-02-28

Clinical manifestations of Hirschsprung's disease (HD) in children aged 1 to 3 years depend on many factors, namely the extent of colonic aganglionosis (CA), the age of patients, the presence of associated congenital malformations and severe complications.

Purpose - to study the features of the clinical manifestations of HD in children aged 1 to 3 years for the early detection and verification of this pathology.

Materials and methods. We conducted a retrospective analysis of the clinical manifestations of HD in 268 children aged 1 to 3 years: 74 (27.62%) children with the rectal form of HD, 187 (69.77%) with rectosigmoid form and 7 (2.61%) with subtotal form. Associated malformations were found in 50 (18.66%). To study the clinical course, we considered the anamnesis, physical examination, data of general clinical laboratory indicators of blood, urine and feces, electrocardiography, neurosonography, echocardiography, ultrasound and X-ray dianostics.

Results. Hypotrophy was found in 54 (20.15%) children: the first degree in 9 (3.36%) children, the second degree in 34 (12.69%) and the third degree in 11 (4.1%) patients. Laboratory tests revealed mild anemia in 4 (1.49%), moderate anemia in 11 (4.1%), and severe anemia in 31 (11.57%) children. The HD course was complicated by enterocolitis in 25 (33.78%) of 74 patients with rectal, in 86 (46.52%) of 187 children with rectosigmoidal and in 7 (100%) of 7 children with subtotal CA. Toxic megacolon was diagnosed in 6 (3.21%) patients.

Conclusions. Associated malformations and late diagnosis are the main causes of severe complications of HD in children aged 1 to 3 years: enterocolitis (44.03%), toxic megacolon (4.85%), hypotrophy (20.15%) and anemia (17.16%).

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all institutions mentioned in the work. Informed consent of the children’s parents was obtained for the research.

No conflict of interests was declared by the authors.

Retrospective analysis of carious lesions of hard dental tissues in children from the territories of Ukraine contaminated by radiation as a result of the accident at the Chornobyl NPP

S.F. Liubarets — 2024-02-28

The relevance of the study is due to the presence of significant carious lesions of the hard tissues of the teeth in children from radiation-contaminated territories as a result of the accident at the Chornobyl nuclear power plant (ChNPP).

Purpose - to conduct a retrospective analysis of the intensity of dental caries in children of Ukraine, residents of radiation-contaminated territories, taking into account the general state of health at different times after the accident at the ChNPP (1993-1996, 2001-2003, 2016-2018) as a basis for the further development of a complex of therapeutic and preventive measures for this pathology.

Materials and methods. The object of the study: 1852 children aged 7-15 - residents of territories contaminated with radionuclides. Assessment of caries intensity of permanent teeth in accordance with WHO recommendations (2013) included determination of caries prevalence and index assessment of caries intensity of permanent teeth (PT): «decayed, missing, filled permanent teeth» (DMFT) and «decayed, missing, filled permanent teeth surfaces» (DMFS). Statistical processing of data was carried out using methods of variational statistics (statistical package «IBM SPSS Statistics 20.0.0»).

Results. In 1993-1996 irradiated children from the III zone had a very high intensity of dental caries (DMFT - 7.25±0.77, DMFS - 10.92±1.77), twice as high compared to residents of the IV zone. In children from III and IV zones in 2001-2003 the intensity of dental caries was higher in the presence of somatic pathology. In 2016-2018 compared to the period 2001-2003 there was a significant (p<0.05) decrease in both indices of carious lesions, probably due to a decrease in the degree of exposure of children to radionuclides.

Conclusions. During the period 1993-1996 the highest rates of dental caries intensity were determined in 15-year-old children from zone III compared to residents of zone IV. The intensity of dental caries during the periods of 2001-2003 and 2016-2018 decreased, although it remained at a high level, which requires the further development of a complex of treatment and prevention measures for this pathology.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the children's parents was obtained for the research.

The authors declare no conflict of interests.

Clinical significance of deblocking of nasal breathing in infants and children of early age with acute respiratory viral infections: advantages of isotonic seawater solution

O.K. Koloskova — 2024-02-28

Acute respiratory viral infections (ARVI) are an urgent problem in young children, which is due to their significant prevalence, they have a constant tendency to increase and occupy the first places in the structure of infectious diseases. Damage to the mucous membranes of the upper respiratory tract in children with ARVI lead to numerous problems that require adequate replacement of the main functions of the child’s body, which determined the relevance of our study.

Purpose - to analyze the effectiveness of the use of isotonic dilution of sea water (Pshyk Mini medicine) for irrigation therapy in nasal congestion in infants and young children caused by acute respiratory infections.

Materials and methods. A comprehensive examination of 100 infants and young children with influenza and other ARVI was conducted in the infectious diseases department of the Chernivtsi Regional Children’s Clinical Hospital. The children were randomly divided into 2 clinical groups: the Group I included 55 children (average age - 1.09±0.3 years, the proportion of boys - 58.1%), who, as part of complex standard therapy, received nasal irrigation using 2-3 drops of Pshyk mini medicine in each nostril 3 times/day. The Group II included 45 patients (average age - 1.15±0.2 years (p>0.05), the proportion of boys - 59.1% (p>0.05)), in whom isotonic sodium chloride solution was used for the purpose of the nasal sanitation.

Results. The conducted studies showed that starting from the 3-4^th day of hospitalization, a statistically significant decrease in catarrhal manifestations and the severity of nasal obstruction was noted in patients of the Group I who received Pshyk Mini in complex treatment. In particular, in relation to the results of the Group II, in the children of the Group I, on the 4^th day of inpatient treatment, the chances of reducing the severity of catarrhal manifestations (estimated ≤2 points) increased: the absolute risk increase - 53.0%, the relative risk increase - 67.9% (95% CI: 57.8-76.9) with the minimum number of patients who need to be treated to obtain a positive result - 1.5. We also established that compared to the representatives of the Group II, children of the Group I had almost a 4-fold increase in the chances of restoring tolerance to feeding (estimation of feeding difficulties ≤2 points): attributive risk - 30.5%, relative risk - 1.6 (95% CI: 0.6-4.8), odds ratio - 3.9 (95% CI: 1.2-12.3).

Conclusions. For the purpose of unblocking of nasal breathing in infants and children of early age at the background of acute respiratory viral infections, the use of an isotonic solution of sea water (Pshyk Mini medicine) has a number of significant advantages compared to the use of an isotonic solution of sodium chloride for this purpose.

No conflict of interests was declared by the authors.

Clinical results of enhanced recovery after surgery in children after pectus excavatum repair

M.O. Ovdii — 2024-02-28

The funnel-shaped deformity of the chest is the most common defect of the chest, which can cause cosmetic problems, but also a decrease in tolerance to physical activity, cause fatigue, shortness of breath and chest pain.

The application of the enhanced recovery protocol and rehabilitation interventions after Nuss procedure are poorly described in the literature.

Purpose - to evaluate the clinical results of using a modified protocol of enhanced recovery after surgical correction of pectus excavatum in children.

Materials and methods. The results of the treatment of 79 patients with a funnel-shaped chest deformity aged (14.2±1.6) who underwent surgical correction of the deformity according to Nuss method were analyzed. Two groups of patients were analyzed, according to the protocol of postoperative management: the Group I (n=20) - patients of traditional postoperative management, the Group II (n=59) - according to the the enhanced protocol of recovery. In the Group II, psychological and physical training was additionally included in the preoperative plan.

Results. The groups were the same in terms of age, Haller index, and time of surgery (p>0.05). The length of stay in the hospital was significantly (p<0.001) shorter in patients of the Group II. The use of the epidural analgesia method in patients of the Group II made it possible to significantly reduce both the dose and the duration of taking opioid analgesics to 1 day, in contrast to the Group I (up to 3 days). The lack of pleural drainage enabled the patient to become more active after a day - to get up, walk, and take some procedures.

Conclusions. The protocol of the enhanced postoperative recovery, which includes a program of rehabilitation treatment, early removal of the urinary catheter and early verticalization of the patient, improves the quality of recovery of patients after reconstruction of funnel-shaped deformity of the chest and reduces the length of stay of patients in hospital treatment after surgery.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the participating institution. Informed consent of the patients was obtained for the research.

No conflict of interests was declared by the authors.

The frequency of anxiety-depressive syndrome in children with inflammatory bowel diseases

T.V. Sorokman — 2024-02-28

Inflammatory bowel diseases (IBD) have been spreading rapidly in industrialized countries since the beginning of the 21^st century.

Purpose - to determine the frequency of symptoms of anxiety and depression in children with IBD, in order to optimize treatment.

Materials and methods. 18 patients aged 10-17 years were surveyed: 10 people with ulcerative colitis (UC) and 8 people with Crohn’s disease (CD), symptoms of anxiety and depression were studied using PHQ-2, PHQ-9 questionnaires (Patient Health Questionnaire) and GAD-7 (Generalized Anxiety Disorder). The obtained results were analyzed using SPSS 26.0 programs. The odds ratio (OR) was considered significant if the 95% confidence interval (CI) did not include 1. The difference in samples was considered significant at p<0.05.

Results. Of the 18 patients who were surveyed using the PHQ-2 questionnaire, 13 (72.2%) were screened for further investigation using the PHQ-9 questionnaire. The prevalence of anxiety symptoms was 55.5% (95% CI: 38.3-66.5), depressive symptoms - 34.8% (95% CI: 21.4-45.8). Patients with CD had higher odds of anxiety symptoms (OR: 1.2, 95% CI: 1.1-3.6) and depressive symptoms (OR: 1.3, 95% CI: 1.1-1.7) than children with UC. There were differences in the severity of anxiety and depression in different pathological conditions (IBD: p<0.01; UC: p<0.05; CD: p=0.05). The frequency of symptoms of anxiety or depression was higher in patients with active IBD than in children with inactive disease (100% and 33.3% and 100% and 45.8%, respectively). Minimal (0-4 points) and mild (5-9) degrees of anxiety and depression prevailed.

Conclusions. The frequency of detection of symptoms of anxiety and depression in children with CD and UC in the active stage of the disease is 55.5% and 34.8%, respectively, with a predominance of minimal (0-4 points) and mild (5-9) degrees. Patients with CD are higher odds of anxiety and depression symptoms than children with UC.

No conflict of interests was declared by the authors.

The course of the post-vaccination period when using combined vaccines from different manufacturers during one vaccination cycle

A.M. Pugach — 2024-02-28

Purpose - to evaluate the postvaccination period when using 6-valent vaccines against pertussis, diphtheria, tetanus, poliomyelitis, hepatitis B and infections caused by Haemophilus influenzae type b from different manufacturers within the same vaccine cycle.

Materials and methods. The study was conducted on the basis of a private health care facility that provides outpatient admission, management, monitoring, and vaccination of children and adults. For the period from January 2020 to October 2023, we analyzed the records in the preventive vaccination registers, which were recorded the next day during routine monitoring of the child's condition after immunization. For the analysis, 343 children were selected and divided into 5 groups depending on the combination of doses of different hexavalent vaccines during the vaccine cycle (3 doses at 28-day intervals) and the first revaccination (one dose at 12-month intervals from the third dose).

Results. In all groups of subjects, most children had no complaints during the postvaccination period. The combination of 6-valent vaccines from different manufacturers was not accompanied by an increase in postvaccination reactions, on the contrary, a tendency to their decrease was noted. Some differences were observed when comparing post-vaccination reactions when using all 4 doses of the 3-component pertussis vaccine and the 2-component pertussis vaccine. Thus, vaccination with a 3-component pertussis component, in 32% was accompanied by a fever up to 38.5°C, and in only 15.38% in vaccine with a 2-component pertussis component, differences were not significant (p>0.05).

Conclusions. In heterologous immunization against pertussis, diphtheria, tetanus, poliomyelitis, hepatitis B and infections caused by Haemophilus influenzae type b with vaccines from different manufacturers with a 2- and 3-component pertussis component, the spectrum and percentage of post-vaccination reactions practically do not differ. Thus, the use of combinations of doses of different 6-valent vaccines is justified, which is especially relevant in the conditions of interruptions in the supply of vaccines and vaccination of children in various medical institutions during migration in war conditions, when there is a risk of delay in the introduction of the next dose of the vaccine and violation of the intervals between vaccinations.

No conflict of interests was declared by the authors.

Difficulty in diagnosing refractory Kawasaki disease under the «mask» of hemoblastosis: a clinical case from the experience of a hematologist

O.I. Dorosh — 2024-02-28

Kawasaki disease (KD) is an acute systemic vasculitis that is the most common cause of acquired heart disease in children under 5 years of age with hyperthermia. Diagnosis of KD is a clinical challenge, given the wide range of clinical manifestations and similarities with many viral and bacterial diseases.

Purpose - to describe a clinical case of refractory КD in a three-month-old girl with an emphasis on the importance of echocardiography and coronary angiography for the final verification of the disease, urgent initiation of treatment with minimal suspicion of КD.

Clinical case. The article reports on a three-month-old patient with a difficult diagnosis of refractory form of КD. The disease debuted with hyperthermia, enterocolitis, obstructive bronchitis, and hepatoliver syndrome. The manifestations of skin exanthema were initially considered as an allergic dermatitis to the use of a cephalosporin antibiotic. Multisystemic inflammatory syndrome associated with SARS-CoV-2 infection was suspected. After the use of immunosuppressive therapy with mega-doses of dexamethasone and intravenous human immunoglobulin 2 g/kg/day for 3 days, clinical improvement was achieved. Subsequently, the haemogram showed an increase in neutrophilic hyperleukocytosis to the appearance of blast cells, hyperthrombocytosis and severe anaemia. A differentiation was made between a leukemic reaction, the debut of myeloproliferative disease, juvenile myelomonocytic leukaemia. Against the background of a rapid decrease in the number of leukocytes, the girl developed hyperthermia, migratory intermittent maculopapular rash, and foots edema. Laboratory findings included thrombocytosis and an increase in acute-phase parameters. Echocardiography revealed left ventricular dilation, a small amount of excess fluid in the pericardium, dilatation of the left coronary artery evenly to the bifurcation. Computed tomography revealed giant coronary artery aneurysms, which gave grounds to diagnose KD.

The study was performed in accordance with the principles of the Declaration of Helsinki. Informed consent of the parents of child was obtained for the study.

No conflict of interests was declared by the authors.

Diagnosis and treatment of toxocariasis in children in modern conditions

T.V. Pochynok — 2024-02-28

Toxocariasis is a parasitic disease that is most often caused by roundworms in cats and dogs. Helminthiasis is endemic throughout Ukraine and causes significant morbidity in children, including damage to the lungs, liver, central nervous system, and eyes.

Purpose - to take into account the large number of displaced persons from the south and east of Ukraine, the growth of the population of homeless animals, the lack of deworming of them and pets, to analyze the data of the clinical examination of children who were treated in the departments of the “DCL No. 4 Kyiv” diagnosis and treatment of toxocariasis in children.

Three clinical cases of toxocariasis in children are presented. 1. A 3-year-old boy was admitted to the clinic with a diagnosis of acute bronchitis. An increase in the titer of toxocarosis antibodies (Ig G 1: 200) was detected, which indicated an invasion that had once occurred, and not an acute disease. The child was subject to dispensary observation by an infectious disease specialist and a general practitioner with an examination every 2 months. When clinical signs of toxocarosis appear, specific therapy is recommended. 2. Boy, 3.5 years old. was in the neurological department due to a neurosis-like condition in the form of sleep disturbance (restless sleep), febrile convulsions in the anamnesis. This case demonstrates the propensity of visceral toxocarosis to a long-term relapsing course, which was confirmed by the detection of IgG - toxocar avid antibodies with an avidity index of 60, which indicates a chronic invasion and requires specific treatment. 3. A 10-year-old girl was being treated in the eye department. The child was diagnosed with ocular form of toxocariasis, treated: anti-inflammatory, anti-parasitic, surgical.

Conclusions. Toxocariasis in children is an urgent problem in pediatrics, and the solution of its aspects depends on the introduction of the latest methods of diagnosis, treatment and prevention into the clinical practice of health care, as well as on the coordinated cooperation of pediatric and veterinary services.

The research was carried out in accordance with the principles of the Declaration of Helsinki.

Informed consent of the child’s parents was obtained for the research.

No conflict of interests was declared by the authors.

Chronic colitis in children. Problems of differential diagnosis

O.G. Shadrin — 2024-02-28

During the last few decades, there has been observed a "rejuvenation" of the inflammatory bowel diseases (IBD) onset in childhood. Very often the problem is narrowed down to the differential diagnosis of Crohn's disease and ulcerative colitis, which are related to IBD, although in reality the spectrum of chronic IBD is much wider. A diagnosed case of microscopic (collagenous) colitis confirms the need for a wide diagnostic search in patients with IBD.

Purpose - to describe differential diagnostic features of collagenous colitis and collagenous gastritis in young children.

Clinical case. Observational data on a patient aged 1 year and 7 months with a special form of colitis (collagenous colitis in combination with collagenous gastritis) are presented. The peculiarities of this rare disease course in the examined patient, in whom the pathology debuted with gastric ulcers with hematemesis, anemia and diarrhea syndrome, were analyzed. The differential search complex stages are discussed in detail, the results of laboratory, instrumental and pathomorphological research methods are described. Information is provided on the treatment prospects of patients with a gastrointestinal tract collagenous pathological process. There is a justified need to take into account rare causes of digestive tract inflammation when observing young patients with a clinical picture similar to the IBD debut.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The informed consent of the child's parents was obtained for conducting the studies.

No conflict of interests was declared by the authors.

The case of Kinsburn’s Encephalopathy in a child with neuroblastoma of posterior mediastinum

T.I. Stetsenko — 2024-02-28

Opsoclonus-myoclonus-ataxia syndrome (OMAS) is an autoimmune rare disease of the central nervous system with lesion of the cerebellum and its ligaments.

Purpose - to present a case of the rare Kinsburn’s Encephalopathy - OMAS and to attract the attention to its timely diagnosis.

Clinical case. A child at the age of 1 year and 9 months was observed in the neurological department of the National Children’s Specialized Hospital “OKHMATDYT”. Neurological status: eyes opsoclonus, truncal tremor, ataxia of the cerebellum. There were also changes in behavior and a sleep disorder. She became sick in 1 month after acute respiratory infection. True diagnosis was made: Kinsburn’s Encephalopathy - opsoclonus-myoclonus syndrome. A study of the child’s immune status was made and, most importantly, computerized tomography (CT) of the whole body. Mediastinal neuroblastoma was diagnosed.

In addition to the diagnosis, the child receive adequate therapy - intravenous immunoglobulin at a dose of 2 g/kg for a 5-day course. On the background of the received therapy, the child was marked with positive dynamics, she began to walk by herself, the atactic syndrome diminished, opsoclonus remained unchanged.

Consequently, the main cause of autoimmune defeat of the nervous system was detected and the child was directed to the further examination and treatment to the Cancer Institute of the National Academy of Medical Science of Ukraine.

Radical removal of the left hemopleura neuroblastoma was made. According to the results of morphological and immunohistochemistry tests, the phenotype obtained in the material of the operation is characteristic of the neuroblastoma (ICD-O code 9500/3), pT1bpN0M0, negative form. In the future, the child continued to receive courses of immunosuppressive therapy.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Viral pneumonia in children: present and future

L.I. Chernyshova — 2024-02-28

Purpose - to attract attention and provide information about modern approaches to the diagnosis of viral pneumonia, which in the future will make it possible to make a more confident diagnosis of viral pneumonia and not to prescribe antibiotics to all patients.

Pneumonia is the leading cause of morbidity and mortality among young children outside the neonatal period worldwide. Not always a detected microorganism or virus in the nasopharynx is proof that it is the causative agent of this particular pneumonia, since healthy carriers of both bacteria and viruses are found quite often. For example, during the examination of healthy children under the age of 5 years in Ukraine, pneumococcal carriers, which are recognized as the leading cause of community-acquired pneumonias (CAP), were found in 21.3% when bacterially examining swabs from the nasopharynx, and when using the PCR method - in 53.8%. However, on in practice, the diagnosis of viral pneumonias was almost never made, and when a diagnosis of pneumonia is made, the first thought about a bacterial infection traditionally arises. Following the emergence of severe acute respiratory syndrome (SARS), avian influenza A (H5N1) and pandemic influenza A (H1N1) viruses in 2009, the important role of respiratory viruses as causes of severe pneumonia has received special attention. Recently, the availability of multiplex PCR-based tests, which allow for the simultaneous identification of a large number of viruses, contributes to an increase in the number of diagnoses of viral pneumonia, increasing awareness of viruses as causative agents of respiratory lung diseases. Clinically, it is not easy to distinguish between viral and bacterial pneumonia. New protocols for the treatment of CAP in children are already being created, which include a set of clinical and laboratory signs that allow us to think about the viral etiology of pneumonia. However, today there is a dissonance: everyone recognizes the predominance of viral etiology of CAP, but at the same time, the main treatment for the most part remains antibiotics. With the expansion of universal vaccination against Hib and pneumococcus, an increase in the share of viral pneumonias among CAP is predicted, which will stimulate the development of drugs against respiratory viruses. We can hope that in the near future not all children will be prescribed antibiotics, which will contribute to reducing the development of resistance of microorganisms to antibacterial drugs.

No conflict of interests was declared by the authors.